Library

Notes: A 20-year-old Korean woman presented in August 1999 with a 3-month history of multiple, tiny papules on the periorbital and malar areas (〈link href="#f14431"〉Fig. 1a). She had noted hyperhidrosis for the preceding 6 months, even at room temperature. She had been well and had received no medication prior to her first visit to our clinic. Physical examination showed yellow colored, translucent, small papules, as well as finger tremor, exophthalmos, and a goiter. Histologic examination demonstrated cystic structures in the dermis lined with two layers of cuboidal epithelial cells (〈link href="#f14432"〉Fig. 2). The epidermis was normal and the rete ridges were partially effaced. Immunohistochemical studies revealed that the epithelial cells of the cyst wall were carcinoembryonic antigen (CEA) positive but S-100 protein negative.〈figure xml:id="f14431"〉1〈mediaResource alt="image" href="urn:x-wiley:00119059:IJD1443_5:IJD_1443_f1"/〉Multiple tiny papules on the periorbital and malar areas before (a) and after (b) treatment for Graves’ disease〈figure xml:id="f14432"〉2〈mediaResource alt="image" href="urn:x-wiley:00119059:IJD1443_5:IJD_1443_f2"/〉Staining with hematoxylin and eosin (× 100); (b) Staining with hematoxylin and eosin (× 200); (c) CEA-positive epithelial cells; (d) S-100 protein-negative epithelial cellsBecause a goiter and finger tremor were noted on physical examination, hyperthyroidism was suspected. Thyroid function test results were: triiodothyronine (T3), 8.0 ng/mL (normal range, 0.7–1.9 ng/mL); free thyroxine (T4), 8.1 ng/mL (0.7–1.9 ng/mL); T4, 35 µg/dL (6.0–11.8 µg/dL); thyroid-stimulating hormone (TSH), 0.04 IU/mL (0.25–4.0 IU/mL); positive for anti-TSH receptor antibody. On the basis of these findings, the patient was diagnosed with Graves’ disease and treated with methimazole, 40 mg/day. As the patient's symptoms improved, the therapeutic dose was decreased to 20 mg/day. Four months after the beginning of treatment, the free T4 and T3 values had returned to the normal range (〈link href="#t14431"〉Table 1). The skin lesions, finger tremor, and hyperhidrosis had also disappeared. Exophthalmos was improved, but still present (〈link href="#f14431"〉Fig. 1b).〈tabular xml:id="t14431"〉1〈title type="main"〉 Comparison of thyroid hormone values in Graves’ disease pretreatment and post-treatment 〈table frame="topbot"〉〈tgroup cols="3" align="left"〉〈colspec colnum="1" colname="col1"/〉〈colspec colnum="2" colname="col2" align="char" char="."/〉〈colspec colnum="3" colname="col3" align="char" char="."/〉〈thead valign="bottom"〉 T3 (ng/mL) Free T4 (ng/mL) 〈tbody valign="top"〉Pretreatment8.08.1Post-treatment1.00.15〈note xml:id="t14431_note3" numbered="no"〉T3, triiodothyronine; T4, thyroxine.